During Richard Wainerdi's tenure as president of the Texas Medical Center, the complex tripled in size and became the equivalent of the nation's 11th-biggest downtown. This fall, the former Gulf Oil Corp. executive and Texas A&M professor of engineering is retiring after 28 years in the job. Wainerdi, whose time in the Medical Center goes back to teaching stints with Baylor College of Medicine in the early 1960s, recently sat down with Chronicle medical reporter Todd Ackerman and reflected on the Medical Center's growth, some of the big events during his tenure and his thoughts on the future.

Q: So what's your mood as you prepare to step down after all these years?

A: I'm sure I'll miss a lot of people, but I'm going to keep my hand in a lot of different things and stick close, such as being a professor at Rice University. There are certain separation anxieties after so long in one job, but at 81 years of age and after 28 years as president, I think it's time to turn the reins over to someone else.

Q: What are your first memories of the Texas Medical Center?

A: I recall that there was a lot to do when I became president - streets were falling apart, institutions were at each other's throats. One institution president would walk out of the room when a particular institution would enter it. That's all changed now. Institution leaders and other officials lunch together, meet regularly, serve on TMC councils. What I remember most was the opportunity, the fact people had great ideas, and we were able to help them work together more.

Q: How dramatic does the growth seem since your early days in the Medical Center in the 1960s? Was it like a small town then in comparison to the veritable city it seems today?

A: No. Even then, it seemed like a very large aggregation of institutions for the times, highly regarded and world famous, the home of Michael DeBakey and Denton Cooley. The difference today in terms of the size of the institutions and their programs is mostly one of continued growth and development. In the '60s, the Medical Center was a collection of hospitals and schools and centers that helped them. Now it's a collection of systems, which have activities and campuses all over the region.

Q: Let's talk about a few things that occurred during your tenure: the DeBakey-Cooley rivalry and, finally, reconciliation?

A: Until they became friends again before Dr. DeBakey's death, I spent a lot of time carrying messages back and forth between them. I believe they respected each other very much, but I think they had very different ideas about how to do things. They represent the pinnacle of what a surgeon can be and ought to be, both of towering stature. The Medical Center owes much of its fame to them.

A: The Baylor-Methodist breakup can only be described as a tragedy, like a marriage of 50 years in which both parties remembered every slight. I think there were communication problems involving different personalities, including Baylor's president (Peter Traber) not being familiar with the culture. I was deeply involved with Dr. DeBakey in trying to stop the split from happening. He was very saddened the efforts failed.

Q: Will the Medical Center always remain a bastion of not-for-profit institutions? As it continues to expand to accommodate institutions on land it doesn't own, will it be able to enforce its prohibition on for-profits?

A: Let me explain something. Many institutions, like the VA and Menninger, joined with their own land. But they're nonprofits. There is nothing that forces our board to accept for-profits. We have agencies of governments and not-for-profits. Our institutions do four things - patient care, research, education and prevention. We have a lot of land we don't own and that is not protected by our covenants, but to become a member the Texas Medical Center requires that you agree in perpetuity to be a nonprofit.

Q: How much of a challenge do you think the Medical Center faces from suburban hospitals, so much more convenient than the Medical Center? They're already killing off "tweener" hospitals.

A: None. When you get really sick, you know where you're going to go.

Q: How big are the challenges the Medical Center faces as a result of the Affordable Care Act and health-care reform generally?

A: They're huge. Health care is so complicated and politically charged. I've never seen so much uncertainty about its future as now, not just in the Medical Center but in the entire country. That's the great challenge - to figure out what we're all going to do, for our parents, for children, for ourselves. If there was ever anything that people need to come together about, it's health-care reform.